Session-6 The DSM-5: Overview of Main Themes and Diagnostic Revisions Flashcards
When was the DSM-IV-TR first issued?
It was first issued in 1994, 968 pages long.
When was the DSM-IV-TR first revised?
It was first revised in 2000, 988 pages long.
When was the DSM-5 initiated?
Update initiated in 1999 and finally published on May 17, 2013, 947 pages long.
What are the DSM-5 sections of the manual?
Section I: Introduction and information on how to use the manual.
Section II: Diagnostic criteria and codes
Section III: Emerging measures and models, conditions that require further research, a glossary, cultural concepts of distress, and names of persons involved in the manual’s development. (where all the new stuff they are adding is located).
Appendix.
How was the DSM-5 developed?
APA organized groups of experts in distinct areas to assess diagnostic categories and disorders;
Came up with consensus viewpoints on symptomatic descriptors;
Field-tested new descriptors to determine revised diagnostic criteria (cluster sets and thresholds).
Presented to APA Board Trustees for sign-off
note: The development of it was political, the way they are supposed to be revised is that they are suppose to do more and more research, they look at patients and do all these analysis. But basically they end up in a room and a political process takes place, representatives from the pharmaceutical companies are connected to the final decision.
What were the primary goals of DSM-5 Task Force in creating the new manual?
Increase cultural sensitivity;
Deepen the clinician’s understanding of the client;
Increase awareness of the neurobiology underpinning mental disorders;
Appraise the role of social and contextual factors associated with psychiatric symptoms.
note:
Neurobiology (bottom-up approach)
Case conceptualization- intra-psychic and contextual factors
What was the first major change to DSM-5?
The multiaxial system has been abandoned.
Axes I, II, and III have been combined.
All clinical disorders are simply listed in order of priority (no real hierarchy of axes implied).
No more GAF (people tended to use very idiosyncratically, and did not follow the symptom severity x impairment rating codes)
What was the second major change to DSM-5?
Incorporate a Spectrum Perspective (based on groupings that reside under the same family)
DSM-5 change to Incorporate a Spectrum Perspective was based on what two emerging realizations?
Based on two emerging realizations in the field:
(1) There is not much evidence that disorders are actually categorically distinct from one another (both within and across diagnostic categories)
(2) The distinction between “normal” and “abnormal” behavior is ultimately, arbitrary.
DSM-5 Incorporate a Spectrum Perspective; OCD was repositioned in what category?
Example: OCD is removed from the “Anxiety Disorders” category (DSM-IV-TR) and repositioned in a new category called “Obsessive-Compulsive and Related Disorders” (DSM-5).
The beam of light going into the prism (underlying core factor of anxiety) splits into several separate but related diagnostic categories.
DSM-5 Incorporate a Spectrum Perspective; The 20 newly-refined diagnostic categories of mental disorders depict…?
updated groupings of all disorders, with each grouping sharing similar characteristics.
note:
Has resulted in a fair amount of reshuffling of the deck, e.g., “Neurodevelopmental Disorders” (includes Autism Spectrum Disorder, ADHD, and other disorders reflecting
abnormal brain development).
What is the third major change to DSM-5?
Incorporate Dimensionality
Diagnostic thresholds (categorical/qualitative) are now supplemented by the degree to which the diagnosis is present (dimensional/quantitative).
Severity ratings (from minimal to more extreme levels): typically, symptom counts.
What is the fourth major change to DSM-5?
Reflect a developmental perspective:
(1) Chapter structure of DSM-5 follows a neurodevelopmental life span approach (congruent with the system used by the ICD [World Health Organization]):
Early development: Neurodevelopmental Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; etc.
Adolescence/early adulthood: Depressive Disorders; Anxiety Disorders; etc.
Later life: Neurocognitive Disorders.
note: The way dsm-5 is organized, in the beginning you have the early developmental..etc. they arranged it so that it is developmentaly congruent with the path of life.
(2) For specific disorders, variations of symptom presentations across the lifespan are described.
What is the fifth major change to DSM-5?
Increase the emphasis on culture and gender.
Cultural information and gender differences are included wherever relevant.
Previous cultural formulation replaced with the Cultural Formulation Interview (CFI; pp. 750-757), a structured clinical interview that assesses the client’s subjective view of cultural factors re: the presentation of symptoms (effort is to diminish the clinician’s own cultural biases).
What is the sixth major change to DSM-5?
Enhance Descriptive Information for Diagnoses:
Many specifiers provided.
Severity ratings provided.
Not Otherwise Specified (NOS) deleted, but here is what they came up with instead: if not meet full criteria for the disorder use “Other Specified” (need to give a reason) or “Unspecified Disorder” (don’t need to give a reason).
What is the 7th major change to DSM-5?
Match the international classification of diseases (ICD) Codes
DSM-5 includes equivalent ICD-9 and ICD-10 codes.
The U.S. will adopt the ICD-10 in October, 2014; however, by that time, most of the world will already be using ICD-11.
note:
ICD codes is the medical world, most of DSM-5 matches ICD-10
What is the 8th major change to DSM-5?
Reinvent DSM to be a “living” document:
DSM-5 (Arabic numeral) vs. DSM-IV-TR (Roman numeral).
More readily incorporate advances generated by new research, neuroscience, and investigations re: the genetics of psychiatric illness.
What is the 9th major change to DSM-5?
Introduce the potential of the so-called “hybrid” model in subsequent DSMs
Do Personality Disorders remain the same in DSM-5 as in DSM-IV-TR?
The Personality Disorders (PDs) essentially remain the same in DSM-5 as in DSM-IV-TR.
Section III of DSM-5 introduces a hybrid…?
Introduces a hybrid (category and dimensional synthesized) model of PDs:
Level of impairment of personality functioning (dimensional) with ….
An evaluation of personality traits (categorical)
note: “whodaf”? Measures new measure like the GAF measure
Personality disorders have a combo of category and dimensionality. 4-TR based with category
DSM-5: What are the five broad domains of personality traits?
(1) Negative Affectivity
(2) Detachment
(3) Antagonism
(4) Disinhibition
(5) Psychoticism
note: As a field, we are moving closer to defining what the core elements of psychiatric health/personality actually are
What is the tenth major change to DSM-5?
Use biologically-based diagnostic criteria:
For some disorders, DSM-5 employs objective measures (genetic work-ups, neuroimaging, neurochemistry) into the criteria sets.
David Kupfer, M.D., the co-chair of the DSM-5 Task Force, indicated a keen interest in genetic tests/brain scanning/biomarkers/laboratory tests, but admitted that the field is not quite there yet.
note: He basically says the dSM-5 was disappointing, they wanted more diagnostic criteria to have more biologically based content in it, like blood tests and things and he is upset that a lot of it is still like psychological systems. He is saying I want 2929 to come now, this field wants to go towards scanning the fetus.
DSM-5:
“Neurodevelopmental Disorders”
Intellectual Disabilities
Communication Disorders
Autism Spectrum Disorder
Attention-Deficit/Hyperactivity Disorder
Specific Learning Disorder
Motor Disorders
Other Neurodevelopmental Disorders
note: The title- diagnostic category, used to be called disorders usually first diagnosed in infancy, childhood and adolescence
DSM-5: “Neurodevelopmental Disorders” : shifts
Separation Anxiety used to be in ____ now in____.
Separation Anxiety used to be in (DSM-IV-TR) “Disorders Usually First Diagnosed in Infancy, Childhood and Adolescence” and is now in (DSM-5) “Anxiety Disorders”
